Chronic retinal necrosis due to cytomegalovirus
C. Administer intravitreal foscarnet and initiate valganciclovir
Based on the constellation of clinical findings, there was high clinical suspicion for cytomegalovirus (CMV) retinitis, so the patient was treated empirically with intravitreal foscarnet, 2.4 mg, and oral valganciclovir, 900 mg, twice daily. Aqueous tap and polymerase chain reaction analysis results returned 3.5 million copies of CMV DNA, confirming a diagnosis of chronic retinal necrosis (CRN) due to CMV.
Cytomegalovirus retinitis typically occurs in patients with severe immunosuppression and has been well described in patients with AIDS.1,2 Cytomegalovirus retinitis often lacks substantial intraocular inflammation and may manifest as either an indolent progressive peripheral granular necrotizing retinitis or as a fulminant posterior hemorrhagic retinitis.1,2